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Application Form
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(printable, MS Word, Zip)
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Available now
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DOWNLOAD
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June
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2001 |
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1.
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Name,
Surname: |
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Date
of birth: |
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Place
of birth: |
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Gender: |
male
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Resident
of: |
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Nationality: |
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Martial
status: |
Married
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No
of children < 21: |
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Next
of kin: |
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Religion: |
Christian
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Address: |
1-a Anystreet
ul., apt.# 7, Odessa 65077 Ukraine |
Phone: |
380-482-777777 |
E-mail: |
yourlogin@domain |
Fax
(YAC) Nr: |
or
any alternative contact |
Nearest
airport: |
Odessa
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2.
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The
positions applied for |
Description |
Second Engineer
|
In May
I upgraded my qualification by attending a simulator-training course in
diesel propulsion plant operation. The same month I took successfully
passed an examination for a First Class Engineer Certificate, which qualifies
me for a post of higher grade than I actually held.
But I agree to work as the Second Engineer the
first contract for acquaintance with a vessel.
References: Available on request.
(place your breef explanation notes
and , for example, your last ref company full style incl e-mail here) |
First Engineer
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3.
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XXXX USD/per month and higher |
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4.
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Country |
No |
Issued |
Valid |
Ukraine |
MC NNNNNN |
14.01.1999 |
06.03.2003 |
|
5.
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Country |
No |
Issued |
Valid |
Ukraine
Panama
Norway |
AB NNNN
OMNNN
NNN/00 |
19.09.1996
29.05.1998
19.09.2000 |
19.09.2002
31.01.2002 |
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6.
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Period |
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Education institution, courses |
No |
Degree |
198X-198X
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Odessa Higher EngineeringMarine
School. (at present Odessa State MaritimeAcademy) (Ukraine) |
PB NNNN
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|
04.1998
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Odessa State Maritime Academy |
NNN
|
Profficiency in survival
craft
(Reg.VI/2 of the STCW'78/95 and 1.23 IMO-model course) |
04.1998
|
Odessa
Maritime Training Centre |
8995
24175
|
Advanced Fire Fighting
(Reg.VI/3 STCW'75/95)
Personal survival, elementary first aid
(Reg.VI/1 STCW & IMO model course 1.13, 1.19, 1.20, 1.21) |
06.2000
|
Odessa
Maritime Training Centre |
xxxx/2000
|
|
06.2000
|
Odessa
Maritime Training Centre |
xxxx/2000
|
Medical Care on Board Ship |
05.2000
|
STS
"Lesozavodsk", Ukraine |
1679
|
Maintenance of electrical and
electronic engineering Certificate ¹ |
06.2000
|
STS
"Lesozavodsk", Ukraine |
2153
|
Simulator training course
in
diesel propulsion plant operation. |
|
7.
|
Country |
Capacity |
No |
Issued |
Ukraine |
Deep Sea Captain |
nnn/2000 |
16.06.2000 |
|
License:
Place of issued: Ukraine, Port of Izmail
Issued by : Izmail Harbour Master (Ukraine) |
Endorsement (Ukraine):
Capacity: Master
Place & date of issuance: Ukraine, Izmail, 16.06.2000
Issued by : Izmail Harbour Master (Ukraine)
Number: NNN/2000
Valid: 14.04.2003
Provisions of STCW: II/2,
Endorsement -1978 Norway
Capacity: Deck Officer Class 2
Place & date of issuance: Oslo, 27.11.2000
Number: NNNN
Valid: 31.01.2002
Provisions of STCW: II/2, II/4 |
Panama |
(indicate your degree) |
12GO0NNN |
29.05.1998 |
|
License:
Place of issued: Republic of Panama
Issued by : Panama Maritime Authority |
Limitations:
NONE
Expiration: 31.01.2002 |
Ukraine |
General Operator
GMDSS |
NNN/99 |
30.03.1999 |
|
License:
Place of issued: Ukraine, Odessa
Issued by : Odessa Harbour Master (Ukraine)
Courses attended:
Black Sea Shipping Co.Training Centre, 1999
Odessa Maritime Training
Centre, 2001
Certificate No. NNN/2001 issued 30.01.2001 |
Endorsement (Ukraine):
Capacity: General Operator GMDSS
Place of issued: Ukraine, Odessa
Issued by : Odessa Harbour Master (Ukraine)
Number: 956 /99
Valid: 30.03.2004
Provisions of STCW: IV/2 |
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8.
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Certificate
Number
Valid |
|
Indicate your license
No. NNN/1999
30.03.2004 |
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Certificate:
Country: Ukraine
Place of issued: Odessa,
Issued by: Odessa
Harbour Master
Model courses:IMO Model Course 1.25
Provision of STCW: IV/2 |
Indicate your license
No. NNN/2000
02.06.2005 |
|
Certificate:
Country: Ukraine
Place of issued: Ukraine, Odessa
Issued by: Odessa
Maritime Training Centre
Model courses:IMO Model Course 1.07
Provision of STCW: A-I/12, A-II/1, A-II/2, B-I/12, Res.
A483(XII) of IMO |
Indicate your license.
No. NNN/2000
02.06.2005 |
|
Certificate:
Country: Ukraine
Place of issued: Ukraine, Odessa
Issued by: Odessa
Maritime Training Centre
Model courses:IMO Model Course 1.08
Provision of STCW: A-I/12, A-II/1, A-II/2, B-I/12, Res.
A482(XII) of IMO |
Elementary
First Aid
No. NNN
15.04.2003 |
|
Certificate:
Country: Ukraine
Place of issued: Ukraine, Odessa
Issued by: Odessa
Maritime Training Centre
Model courses:IMO Model Course 1.14
Provision of STCW: A-VI/4-1 |
Personal
Survival Techniques, Fire prevention and
fire fighting, personal safety
and social responsibilities
No. 7777 |
|
Certificate:
Country: Ukraine
Place of issued: Ukraine, Odessa
Issued by: Odessa
Maritime Training Centre
Model courses:IMO Model Course 1.13, 1.19, 1.20, 1.21
Provision of STCW: A-VI/1-1 |
Proficiency
in Survival Craft and Rescue Boats
No. 7777 |
|
Certificate:
Country: Ukraine
Place of issued: Ukraine, Odessa
Issued by: Odessa
Maritime Training Centre
Model courses:IMO Model Course 1.23
Provision of STCW: A-VI/2-1, A-VI/2-2 |
Indicate
your license
No. NNN
15.10.2004 |
|
Certificate:
Country: Ukraine
Place of issued: Ukraine, Odessa
Issued by: STS
"Lesozavodsk" - Odessa (Ukraine)
Model courses:0
Provision of STCW: B-V/4, B-V/5 |
Medical
Care
No. NNN
31.05.2005 |
|
Certificate:
Country: Ukraine
Place of issued: Ukraine, Odessa
Issued by: STS
"Lesozavodsk"
Model courses:IMO Model Course 1.15
Provision of STCW: A-VI/4-2 |
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9. Previous seagoing and non-seagoing experience |
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Period |
1988-1993 - Soviet Danube
Shipping Company |
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GIVE YOUR BRIEF DESCRIPTION RE
SHIPS AND POSITIONS SERVED ON |
3rd Engineer
|
2nd Engineer
|
Chief Engineer
|
|
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1993-2001- Service in
foreign companies |
2-nd Engineer
|
GIVE YOUR BRIEF DESCRIPTION RE
SHIPS AND POSITIONS SERVED ON |
Chief Engineer
|
|
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|
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10. Seagoing experience at least for
the last 5 years |
Vessel |
Position |
"Alfa" (bulk)
18000 BHP
(june-2000 - jan2001) |
Chief Engineer |
<
Place your breef comments re your service onboard this vessel> |
"Beta" (Gen. Cargo)
18000 BHP
(june
1999 - jan2000) |
Chief Engineer |
<
Place your breef comments re your service onboard this vessel> |
"Gamma" (Reefer)
18000 BHP
(may 1998 - dec 1998) |
2-nd Engineer |
<
Place your breef comments re your service onboard this vessel> |
"Delta" (General Cargo) 18000
BHP (sept 1997 - dec 1997) |
2-nd Engineer |
<
Place your breef comments re your service onboard this vessel> |
|
11. Languages |
Language |
Self evaluation |
English - Marlins Test
: 96% (Anchor, Odessa, Ua)
Spanish
Polish |
My english is fluent, spanish is
good and polish - conversational. |
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12. Merits, rewards, titles, hobbies,
interests, etc. |
Computers, Books, Travelling
and everything, related to the Sea |
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Photografs
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N/A yet |
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Application
Form (printable, MS Word, Zip) |